Doctors miss memory problems in heart patients

NEW YORK (Reuters Health) - Almost half of older heart
patients in a new study had memory loss, though their
cardiologists failed to recognize the impairment most of the
time.

"Detection of memory impairment is very important in elderly
heart failure patients," the study's lead author, Dr. Olivier
Hanon, told Reuters Health in an email.

Memory loss may affect how well people with heart failure
stick to their medications, said Hanon, from Broca Hospital in
Paris. Their chances of dying are known to increase with their
thinking and memory problems.

Hanon and his colleagues studied 912 people who were at
least 70 years old, hospitalized for heart failure in the past
year and under the care of one of nearly 300 private practice
cardiologists throughout France in 2009.

Heart doctors rated their patients' cognitive ability as
either normal or impaired before administering a four-word
recall test.

Based on the screening test, cardiologists diagnosed memory
shortfalls in 46 percent of patients. They had recognized
deficiencies in only 12 percent before testing, the researchers
reported in The American Journal of Cardiology.

Past studies have also tied heart disease to memory loss.
One recent report, for instance, found older women with a
history of heart trouble were more likely to develop memory
problems than women with healthy hearts (see Reuters Health
story of January 3, 2014 here: reut.rs/1di55am).

Though doctors' failure to recognize memory loss has been
widely documented, Hanon said the pervasiveness of missed
diagnoses surprised him.

"Cardiologists were mainly misled by patients with memory
impairment who . . . appeared 'normal,' " he said.

Cognitively impaired people are less likely to take their
medications, show up for appointments and make recommended diet
changes, the authors write. Early identification of memory
changes through testing would enable cardiologists to develop
strategies to help patients stick to their treatment plans, they
say.

Hanon recommended that cardiologists test thinking and
memory skills when they first examine patients and each year
thereafter.

But cardiologist Dr. Liviu Klein of the University of
California San Francisco Medical Center told Reuters Health he
disagrees that cardiologists should routinely perform memory
tests.

Klein, who was not involved in the current study, said he
tests patients for memory impairment before they receive
invasive therapies, like heart transplants, which would be
inappropriate for dementia patients.

Outside of those instances, he said he believes testing for
memory problems should fall to primary care physicians.

"As cardiologists, our training is to deal with heart
issues," he said. "We're not trained to deal with other issues."

If cardiologists were expected to test for cognitive
impairment, they might also have to test for depression and
other ailments, Klein said.

"Then you have a patient who comes to see you for half an
hour, and they spend three hours," he said. "And they don't
really like that."

But primary care physicians may not routinely be testing
thinking and memory skills either. A 2010 German study found
only 11 to 12 percent of general practitioners recognized mild
cognitive impairment in their patients, Hanon's paper noted.

The current study showed that severity of memory impairment
increased along with severity of heart failure. However, that
association seemed to be at least partly explained by
differences in education, exercise habits, depression and other
diseases between people with different stages of heart failure.

Participants were taking an average of more than four heart
medications each. The authors found no differences in memory
loss based on treatment, Hanon said. He could not rule out that
specific antidepressants impaired cognition.

Hanon and five of the six other authors reported receiving
honoraria from Menarini, an Italian pharmaceutical group that
makes cardiovascular products and also funded the study.

SOURCE: bit.ly/1jACVN8 The American Journal of Cardiology,
online January 16, 2014.

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